脑白质高信号合并认知障碍患者脑白质损伤程度的评价  

Evaluation of the degree of white matter damage in patients with white matter hypertensities and cognitive impairment

作　　者：王诗男 王金芳 石庆丽[3] 李越秀[3] 陈红燕[4] 冯丽 张玉梅[3] Wang Shinan;Wang Jinfang;Shi Qingli;Li Yuexiu;Chen Hongyan;Feng Li;Zhang Yumei(Department of Neurology,Hebei Yanda Hospital,Langfang 065201,China;Department of Neurology,General Hospital of The Yang Tze River Shipping,Wuhan Brain Hospital,Wuhan 430000,China;Rehabilitation Medicine Department,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Imaging,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]河北燕达医院神经内科,廊坊065201 [2]武汉长航运总医院神经内科,430000 [3]首都医科大学附属北京天坛医院康复医学科,100070 [4]首都医科大学附属北京天坛医院影像科,100070

出　　处：《中华行为医学与脑科学杂志》2020年第6期546-550,共5页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：北京市医院管理重点医学专业发展项目(ZYLX201836);河北省重点研发计划项目(172777145);河北省医学科学研究课题项目(20190148);廊坊市科学技术研究与发展计划项目(2018013010)。

摘　　要：目的探讨弥散张量成像骨架化平均扩散率峰宽评价不同程度认知障碍患者脑白质纤维束损伤程度的应用价值。方法首先采集所有受试者人口学特征和血管危险因素,利用磁共振成像(magnetic resonance imaging,MRI)筛选出无脑白质高信号(white matter hypertensities,WMH)且蒙特利尔认知评估(Montreal cognitive assessment,MoCA)量表评分≥26分的50例健康志愿者(对照组)。MRI筛选有WMH者85例,均完善MoCA量表及临床痴呆评定(clinical dementia rating,CDR)量表测评后,分为认知正常组(WMH-CN组)45例、非痴呆型血管性认知障碍组(WMH-VCIND组)23例、血管性痴呆组(WMH-VaD组)17例。采用基于弥散张量成像(diffusion tensor imaging,DTI)骨架化平均扩散率峰宽(peak width of skeletonized mean diffusivity,PSMD)标记方法对WMH伴不同程度认知障碍组及对照组患者脑白质纤维束完整情况进行对比研究。结果四组间PSMD值比较差异有统计学意义(WMH-CN组:3.558±0.157,WMH-VCIND组:4.128±0.222,WMH-VaD组:5.469±0.000,对照组:2.612±0.105,F=42.479,P<0.05)。组间比较,WMH各组PSMD值均高于NC组(均P<0.05)。WMH-VCIND组较WMH-CN组间差异无统计学意义(P=0.067)。WMH-VaD组PSMD值高于WMH-CN组和WMH-VCIND组,均差异有统计学意义(均P<0.05)。结论PSMD可以准确检测出WMH造成的脑白质纤维损伤。WMH合并认知下降的程度与PSMD增加的程度并不完全一致;相比WMH认知正常者,WMH合并VCIND时PSMD增加并不显著,合并VaD时PSMD才会显著增加。PSMD值作为影像标记物可以为临床诊断WMH-VaD提供客观依据。Objective To analyze the characteristic of nerve tracts in different stages of cognitive impairment caused by white matter hypertensities,applying diffusion tensor imaging-peak width of skeletonized mean diffusivity as evaluation indicator.Methods Demographic characteristics and vascular risk factors of all subjects were recorded.Screened out 50 subjects without WMH and whose MoCA scale was more than or equal 26 points as normal control group.Then,we assessed 85 patients with WMH using the MoCA scale and clinical dementia assessment.Of 85 patients,45 cases were divided into the normal cognition group,23 cases were assigned into non-dementia vascular cognitive impairment group,and 17 cases into the vascular dementia group.The diffusion tensor imaging-peak width of skeletonized mean diffusivity marking method was used to compare the integrity of white matter fibers in WMH patients with varying degrees of cognitive impairment and normal control group.Results The difference of PSMD among the four groups was statistically significant(CN group:3.558±0.157,VCIND group:4.128±0.222,VaD group:5.469±0.000,NC group:2.612±0.105,F=42.479,P<0.05).PSMD in WMH groups were higher than that in NC group(all P<0.05).There was no significant difference between WMH-VCIND group and WMH-CN group(P=0.067).The PSMD of WMH-VAD group was higher than that of WMH-CN group and WMH-VCIND group(both P<0.05).Conclusion PSMD can accurately detect white matter fiber damage caused by WMH.The degree of WMH combined cognitive decline was not completely consistent with the degree of PSMD increase.Compared with the cases with normal WMH cognition,PSMD was not significantly increased when WMH was combined with VCIND,while PSMD was significantly increased when WMH was combined with VaD.DTI-PSMD value as imaging marker can provide objective basis for clinical diagnosis of WMH-VaD.

关 键 词：脑白质高信号 血管性认知障碍 弥散张量成像 骨架化平均扩散率峰宽 

分 类 号：R743[医药卫生—神经病学与精神病学]